Provider Demographics
NPI:1013005313
Name:STANLEY, KELLEY J (MD)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:J
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:180 CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3418
Mailing Address - Country:US
Mailing Address - Phone:207-524-3501
Mailing Address - Fax:207-524-2093
Practice Address - Street 1:11 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04259-7035
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-933-9645
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1013005313Medicaid
110069191OtherRAILROAD MEDICARE
IL9815737OtherBLUE CROSS BLUE SHIELD
IL105228OtherHEALTH ALLIANCE MEDICAL
IL9815737OtherBLUE CROSS BLUE SHIELD